Provider Demographics
NPI:1174827919
Name:FELIX ANTHONY SOSA MD PA
Entity Type:Organization
Organization Name:FELIX ANTHONY SOSA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SOSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-631-5555
Mailing Address - Street 1:780 E MERRITT ISLAND CSWY STE 6C
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-3562
Mailing Address - Country:US
Mailing Address - Phone:321-631-5555
Mailing Address - Fax:321-262-0836
Practice Address - Street 1:780 E MERRITT ISLAND CSWY STE 6C
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-3562
Practice Address - Country:US
Practice Address - Phone:321-631-5555
Practice Address - Fax:321-262-0836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066702207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272495200Medicaid
FLEH778AOtherMEDICARE PTAN